Inattentional blindness in anesthesiology: A gorilla is worth one thousand words

People are not able to anticipate unexpected events. Inattentional blindness is demonstrated to happen not only in naïve observers engaged in an unfamiliar task but also in field experts with years of training. Anaesthesia is the perfect example of a discipline which requires a high level of attention and our aim was to evaluate if inattentional blindness can affect anesthesiologists during their daily activities.

An online survey was distributed on Facebook between May 1, 2021 and May 31, 2021. The survey consisted of five simulated cases with questions investigating the anesthetic management of day-case surgeries. Each case had an introduction, a chest radiography, an electrocardiogram, preoperative blood testing and the last case had a gorilla embedded in the chest radiography.

In total 699 respondents from 17 different countries were finally included in the analysis. The main outcome was to assess the incidence of inattentional blindness. Only 34 (4.9%) respondents were able to spot the gorilla. No differences were found between anesthesiologists or residents, private or public hospitals, or between medical doctors with different experience.

Our findings assess that inattentional blindness is common in anesthesia, and ever-growing attention is deemed necessary to improve patient safety; to achieve this objective several strategies should be adopted such as an increased use of standardized protocols, promoting automation based strategies to reduce human error when performing repetitive tasks and discouraging evaluation of multiple consecutive patients in the same work shifts independently of the associated complexity.